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,APPLICATION FOR SANITATION PERMIT Permit No. -11.A- /_ <br />` ��0u��� <br />Duplicate) ` <br />(Complete '—` Du+e |oua6This Permit Expires I Year From Date Issued , <br />� -~%% <br />Application hereby mm6o to the Sun Joaquin Local Health District for * permit +oconstruct and install the work herein described. <br />This application is made in compliamcii with County Ordinance No. 549. <br />JOB ADDRESS AND LOCATION-_' <br />Woe <br />. -_ _/ _� -------------------------- I --------------------- ---------------------- <br />Installation will serve: - Residence X].JApartment House E] Commercial E] Trailer Court [-] Motel [-] Other <br />Wafer Supply: Public system [I C,ommunity system Q Private X Depth to Wafer Table,57-0- ft. <br />Character of soil fo'a depth of 3 feet: I I Sand [] Gravel'E] Sandy Loam Clay Loamk , Clay [] Adobe Hardpan <br />Previous Application Made. YeAkL No New Construction: Yes ;R No E] FHA/VA: Yes [I No [I <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool per6iffed if public sewer is available within 200 feet.) <br />D;sposal Field: Distance from nearest well - ------- <br />NLfmber of <br />Com wn a ion <br />Distance to near t Il 100.'. _-Disfanfl) <br />Number of pits --- * ---------------- Linln*g r;ateria�� ---- Size-. Diameter ---- 3-3 ------------- Depth �-r ------------------------ <br />Cesspool: Distance from nearest well ----------------- Dis'fan�e_fjrom ounclation -------------------- Lining maferial ----- <br />1-1 . OF i" <br />-------------------- <br />Remodelingand/or repairing (cle:c,i6�):--------------------------------------- --------------------------------- .------------------- ---------------------- --------------------------------- <br />_--_-_--_-___---^------- .1 <br />---'-------'''-''--''-'--'`i--'-----�---'''-----'---''--'---'-'------'-''---------''-'~''-'—I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Countyordinances, State laws, and rules and 'regulations of the San Joaquin Local Health District.(Plot plan, showing size of lot, location'of system in relation to wells, buildings, etc.,, can be placed on reverse side).FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY_ --------------------------------------------------------------- DA --- <br />REVIEWEDBY'''-'-----''---'-- -------------------- ----------------------------------------------- <br />QU|UD|NG�PERMIT ISSUED .-_-'---��_---'��-'--''-'-__'-------------------------------------- DATE --------------------------------------------- ----- ___ <br />AKermtionsmnJ/orrecommwn6a|ions:--l_-_--.------'-----_-.-__--__----_---'___----.____._____ <br />.—'-'-'_-_''-_'--'_-''-''''_'--''--'---''__�-'--.--_'---.—_''-_._----_'-'-'''-_-_-------- <br />'-'------''-_'--.'-'---'--=-'-'-'''_-'--'^'-_--__.---_'----'-_''--.----'---.'''_—''-'-'--'-- <br />-------------._-----__----.--�--------------- ---- ------------------------ -------------------------------------------------------------------------------------- <br />----------------------- -'-'------''''------- -�''-'''---'---'-''''-'--'-`,—'''-''+''-'-�---------------- .............. <br />�� <br />RN/\L INSPECTION BY: --------.. Duhu.���v,--��@-------------------------------------- ------------- <br />IAN JOAQU|NLOCAL HEALTH D|ST�CT <br />/am South American s�v* i wmvv°�Oak s�°° /»z Sycamore Street ow North "C" Street <br />L <br />Stockton, California, Lodi, California Manteca, California Tw"v. California <br />| <br />ES -9-2m Revised ,-,r,.Pzo. ' <br />